When it came to trying to get pregnant, Brynne Cramer had some worries. “Because I have celiac disease, I was initially very concerned about my ability to conceive and carry a healthy baby to full-term,” says Cramer, who runs the blog Gluten-Free Hungry Gal.
Symptoms of undiagnosed celiac disease include infertility and recurrent miscarriage. Although Cramer was diagnosed four years prior to trying to conceive, she was nevertheless anxious over the impact celiac disease might have on her fertility and a pregnancy. “I was very nervous,” she explains. “It’s part of the reason we decided to start trying for a baby at a younger age .”
Given infertility and miscarriage are symptoms of undiagnosed celiac disease, it’s logical to question whether they could extend into diagnosed celiac disease. Would these issues continue once diagnosed and adhering to a gluten-free diet? Expanding upon that initial thought, a larger question arises about where diagnosed celiac disease fits into pregnancy: Do celiac disease and the gluten-free diet affect pregnancy?
The gluten-free diet and pregnancy
Depending on factors such as ingredients and the absence or presence of nutrients, gluten-free products can be less nutritious than their gluten equivalents. This raises the question of whether a woman with diagnosed celiac disease needs to approach her prenatal care differently because she is on a gluten-free diet.
“Though the gluten-free diet can sometimes be a vitamin-deficient diet, and folic acid is a particular concern with regard to the developing fetus, the recommendation is the same for celiac patients as non-celiac patients: take a daily prenatal multivitamin,”explains Benjamin Lebwohl, M.D., M.S., director of clinical research [MF1] at The Celiac Disease Center at Columbia University, by email.
Folic acid, found in fortified foods such as cereal and in vegetables such as leafy dark greens, is very important in general, and especially during pregnancy. As the Centers for Disease Control and Prevention (CDC) states on its website, “Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.” When it comes to pregnancy, the CDC explains, “Folic acid is very important because it can help prevent some major birth defects of the baby’s brain and spine (anencephaly and spina bifida).”
The nutritional focus during pregnancy is the same regardless of whether one needs to eat gluten free. “All women need to be conscious of their nutrition when they are pregnant,” explains Amy Jones, M.S., R.D., L.D. “Ideally, getting your nutrition in order before you get pregnant is best.” For someone with celiac disease, this would mean “being well controlled on the gluten-free diet” as this “can go a long way in helping to ensure a healthy pregnancy.” Should a woman have any nutritional deficiencies, Jones says to “work with your physician and dietitian to get those corrected, ideally, before you conceive.”
Regardless of celiac disease, pregnant women often experience constipation in their second or third trimester. For alleviating constipation, Jones points out that “the higher fiber of whole grains may be beneficial.” When eating gluten-free whole grains, Jones says, “be sure to drink enough fluid when you are consuming high-fiber foods.” The benefits of gluten-free whole grains extend beyond fiber. “For example, teff has a lot of calcium, and quinoa has a lot of iron and protein,” Jones notes.
The calcium found in teff and dairy products is an important nutrient during pregnancy. Jones mentions that “for pregnant women who have celiac disease who may be lactose intolerant, it’s important to find a good source of calcium and vitamin D.” For those who can tolerate some lactose, she points to yogurt and cheese, which are both low in lactose. “Supplementation of calcium and vitamin D may be necessary as well,” she says.
Cramer learned firsthand that her diagnosed celiac disease did not prevent her from getting pregnant or carrying a baby to term. “To my surprise, we got pregnant very quickly,” says Cramer. “I was anxious at every appointment, but things kept checking out wonderfully.”
Throughout her pregnancy, Cramer found herself feeling like “a typical pregnant woman.” This included enjoying random indulgences—buffalo sauce and chocolate milk. She recommends that pregnant women with celiac disease “find what gluten-free foods hit the spot and indulge every once in a while. We give up so much already as celiacs—depriving yourself during pregnancy seems silly.”
Cramer and her husband welcomed a beautiful and healthy baby girl last summer.
Susan Cohen is a New York freelance writer. She contributes regularly to Gluten-Free Living.